Proposition 51K2966

Projet de loi modifiant la législation en vue de promouvoir la mobilité des patients.

General information ¶

Authors

CD&V Jo Vandeurzen
LE Véronique Salvi
MR Daniel Bacquelaine
Open Vld Yolande Avontroodt, Jacques Germeaux
PS | SP Yvan Mayeur
Vooruit Maya Detiège

Submission date

March 7, 2007

Official page

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Status

Adopted

Requirement

Simple

Subjects

foreign national health policy hospital expenses social security medical institution hospitalisation health insurance

Voting ¶

Voted to adopt

CD&V Vooruit Ecolo LE PS | SP Open Vld N-VA MR VB

Contact form ¶

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Discussion ¶

April 12, 2007 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, I am presenting a brief report on the discussion in the Committee on Public Health, Environment and Social Renewal on the bill amending the legislation with a view to promoting patient mobility, as discussed in the committee meetings of 20 and 27 March 2007.

The main speaker of this bill, Mrs. Avontroodt, points out that she is implementing resolution no. 2494 relating to the mobility of patients within the European Union. The resolution was based on the principle not to jeopardize the treatment of foreign patients for Belgian patients and that the accessibility and quality of Belgian healthcare should be ⁇ ined. The reception of patients from the European Union must also take place within the framework agreement between the country of origin and Belgium. The inclusion of foreign patients in subsidised hospitals should not lead to artificial waiting lists to create two-speed health care. A possible overcapacity of hospitals can be used for this purpose.

The hospitals that treat foreign patients must do so without resorting to subsidies, but the quality must still be ⁇ ined. The Belgian hospitals can thus grow into reference centres to contribute to the development of the knowledge economy and to increase the attractiveness of Belgian healthcare institutions to qualified specialists.

It should also ensure that measures between public authorities and insurance institutions in connection with cooperation agreements between hospitals and public authorities or insurance institutions with other EU Member States are guaranteed. The foreign patients come mainly from the Netherlands and Britain. The expenditures in the Belgian health and disability insurance in connection with international agreements amount to approximately 2.66% of the RIZIV budget.

The prices charged are not currently cost-covering. Budget financial resources are calculated based on the average patient, but the foreign patient is usually not the average patient, as he comes for severe pathology or for severe medical interventions. 60% of the investment in the construction and equipment of hospitals is financed by the Regions and the Communities. The remaining 40% will be depreciated within the budget financial resources. This means that 60% of the investment costs will not be transferred to foreign patients.

The bill also provides for the establishment of an observatory aimed at providing information on waiting lists, accessibility, quality and registration of foreign patients. This observatory is established within the RIZIV.

In the general discussion, Ms. De Meyer may be involved in the establishment of the observatory. Mr Vandeurzen gives a very comprehensive explanation in which he has a problem with financing, because it is not transparent. He does this primarily on behalf of the hospital that he knows very well. Mr. Jacques Germeaux points out that the purpose of the bill is to reflect the correct price for the care provided and the treatment provided. The bill is adopted by unanimous vote.

Thank you, Mrs. the reporter. For the general discussion, I see that Mrs. Avontroodt is registered. You are the chief employee. Mr Goutry ? Do I see well? Yes Mr Goutry. I almost looked around, but I can’t do that. First Mrs. Avontroodt and then Mr. Goutry.

First of all, I would like to express my gratitude for the constructive cooperation of all members of the Committee on Public Health. My express gratitude goes to those who supported the proposal, namely colleague Mayeur, colleague Detiège, colleague Vandeurzen, colleague Salvi, colleague Bacquelaine.

The [...] [...]

Unanimity is everyone.

I mentioned the Indians. I have explicitly mentioned the names of the people who have walked the way with the preparatory work, in particular also the people behind the scenes, the technicians who have supported us and also the cabinet of the minister. This includes the consultation of the technicians, Mr. Tant. A word of thanks can be given from time to time.

Patient mobility is no longer a vision of the future, it is a reality. Belgium is a country that, according to the study ‘The patient mobility in the European Union: learning from experience’, of all the Member States of the European Union, treats the most foreign patients within the framework of Article 22 of Regulation 14.08/71, that is, with the consent of its own insurer in the form of a form E 112.

However, that is not the most important thing. The most important thing – the reporter has expressed this very well – is that our health care facilities are today a source of knowledge economy. It is also this government that has given the pharmaceutical sector a number of impulses, oxygen to be able to promote research and development and to keep the knowledge and the brains at home and be attractive in the field of research and development.

Of course, there were some technical limitations. The first point, which colleague Vandeurzen, by the way, spoke very explicitly, concerns the budget financial resources. Hospitals that treat foreign patients are of course the most beneficial. Because it is a closed envelope, it is detrimental to the other hospitals, because solidarity does not play. The amount per point – which is a technical issue – decreases, resulting in hospitals that do not treat foreign patients being penalized.

In addition, there is the problem that the actual costs cannot be charged. Here too, we have tried, with our bill, to offer a solution. We have asked this government to regulate this with implementing decisions.

Removing legal barriers without, of course, interfering with European regulations has been one of the biggest tasks.

The repeal of the existing article 104b of the law on the hospitals, which today prohibits a foreign patient from being charged a price different from that of a Belgian patient, is repealed by this bill. This applies only to non-European citizens.

There were concerns and concerns. Also in the committee, the thumbnail of commercialization, the medicine of two speeds, and so on has been raised for a while. In order to prevent this from happening, with this bill we put the establishment of an observatory for patient mobility in a legal framework. That observatory has the task of collecting data, for example from which countries the patients come from and for what type of care they provide to our country, and this not only for mapping the inflow, but above all for monitoring the data, to avoid waiting lists and to monitor the quality of the care.

Legal barriers have been removed. We are aware that the contracts that are also given to the executive power are not simple, as they will also need to be further reviewed within the framework of European regulation.

I have also had the opportunity to follow this movement internationally and I know that the debate is also being held in the other European Member States. Patient mobility will only increase. It is good that in Belgium, in the heart of Europe, we create a legal framework for this.

Thanks to the establishment of the observatory and the stimulation of the knowledge economy, we give more oxygen to the excellent care we can provide, which will only benefit the Belgian patient. Thus we can put Belgium on the map as a centre of excellence for good care in Europe and in the world.

I believe that the bill ⁇ implements the resolution of colleagues Germeaux and Déom, who have done the preparatory work by pouring out the conditions in their resolution, which was unanimously approved by the House and the Senate. That is a sign, colleague Goutry, that a resolution can also come into effect.

I thank you and I thank again all my colleagues in the committee.

Mr. Speaker, this nightly event illustrates how active our Public Health Committee is and how it has worked in the last few weeks.

Mr. Goutry, is it very healthy what we are doing?

For now, I have no problem with this, Mr. President. Are you in trouble?

I am not.

I think we are both healthy.

That gives pleasure. We are cheap.

Next, there will be an important debate about dogs and cats. There are a few interesting topics from Public Health, which will be presented to you later, colleagues. We are going to encounter a brilliant night full of knowledge, full of interesting files, well documented. We will have dust to go to the campaigns, to replenish our programs. We rarely come home so cleverly. We are much smarter than we left this morning because we had the courage to do such an important job here today.

I thank the majority for having the providence to concentrate that work on the same day that they made such a great agenda today. Otherwise it would have been impossible for us to deal with that, even in the length of the coming year. It adorns the purple majority that they have done nothing for so long and now, at the very end, just before the elections, they are still trying to shut everything through the Parliament. We are very happy to work on this, loyal as we are, especially since we are threatened by the President that we will never have a chance to get in the majority again. Therefore, we will be more opposed from the opposition, colleagues. That for introduction.

Ladies and gentlemen, dear colleagues, Mrs. Dr. Avontroodt – honour whoever deserves honour – has been one of the exciting forces behind the initiative. I am also speaking on behalf of our good chairman, Jo Vandeurzen, who has indeed contributed. I have the impression that he is watching and listening to me, so I will do my best.

Our good chairman was co-initiator of the resolution. Mrs Avontroodt, together we have been able to participate in a number of interesting conferences, including VBO, and other study forums, in which more than ever the need for regulation has become clear.

It is a bill and not a resolution!

Yes, that is right. I did not understand what Mrs. Avontroodt meant when she said that the resolution was unanimously adopted. It is a bill, potverdorie. You have offended yourself. The resolution was from Mr. Germeaux, but here it is a bill.

Well, Mr. Goutry: You have now understood it. I wanted to demonstrate by example that a resolution, in this case that of Mr. Germeaux, was also effectively converted into a law.

I can even tell more details. That resolution even dates back to the time that Mr. Germeaux was in the Senate! Rightly ?

The resolution then came here and Mr. Germeaux followed his resolution. This was the solution: Mr. Germeaux followed his resolution. Collega’s, what Mr. Van der Maelen notes very fresh, vigilant and alert is correct: it is a legislative initiative that may be supported across chambers, since we have done so in the committee. This, in fact, addresses a number of important problems, as Ms. Avontroodt has already emphasized.

Ms. Avontroodt explained to you that the hospitals are financed with a closed envelope. Its amount shall be re-established each year during the sub-budget discussion prior to the general budget. All Belgian hospitals must do this together for all their patients. In other words, if at some point, due to exogenous factors, much more patients use the services within the closed envelope, the rinse is naturally thinner. This means that the budget must be divided by so many units.

We are now threatened by the increase in international patient traffic: it happens quite often, especially in border areas, that many foreign patients get care in our hospitals. That indicates the good quality of our hospitals, but at the same time tax that our budget, because they count as a unit, which then comes into the denominator, which of course makes the fraction then smaller and the amount that one can spend in the hospitals, also becomes smaller. So that was the essential problem, which I think may even be explained understandably because no one can track hospital funding today. It is an incredibly complicated mechanism.

However, this does not apply to the subject. In this regard, we must be able to neutralize the phenomenon for the budget of financial resources of a hospital and that we cannot depend on a stream of foreign patients using the services. The bill requires investigation on this. The bill establishes an observatory, a kind of observation post, a research center, a knowledge center, name it as you want. By the way, it is the second time that we create something like this on a bath afternoon. We have already created an observation post for the OCMW. We already have a knowledge center. We have a pharmaceutical agency. Now we will create another observatory to monitor the international movement of patients. There will be no end. The originality of the Room will remain in memory for a long time.

Mr. Speaker, there are a few colleagues whose medicines are clearly drawn up. The inventory may need to be replenished. Keep calm, that can fix a lot.

Mr Germeaux, you pointed out the problem of hospital financing in your resolution at the time. I think that was very wise from you. You have the honor of paying attention to this. Eventually, the text is then transformed into a room-wide initiative.

In addition, the proposed legislation prevents a problem of waiting lists. The VBO pretends – I deeply doubt that – that we would have a reasonably large overcapacity per year in the hospitals, which we should actually commercialize through medical tourism.

This is the statement of the medical tourism of the VBO. We do not tolerate this statement, because we find the term “medical tourism” wrong. In addition, the commercialization of care activities was countered by the impulse of Mr. Demotte, who together with his colleagues at the European level took a very important initiative to block the Bolkestein Directive in the field of health care.

Congratulations Mr Minister. You have done very important, groundbreaking work in this area. We would be happy to join your initiative.

It is precisely for this reason that we need to have the correction. Otherwise, there are waiting lists that we do not have, thank God. We are almost the only country in the world that provides health care without waiting lists and where people can be helped very quickly. It is completely different than in the Netherlands. This is why Dutch patients also come to us. This is quite different than in Britain and other countries.

We must be able to maintain that system. However, we will have to regulate it through, among other things, the said observatory, which will have to monitor the system.

Ms. Avontroodt correctly noted that the observatory will primarily have to do the registration. It is wise to address a problem first at the source and not immediately at the solution. First, we need to look at what the problem is, how large the problem is, with what it relates, what are the factors that drive, cause and influence the problem and how we can respond appropriately to it so that we can establish a structural system to deal with a structural problem.

In that sense it is very valuable. That is why our President and of course our group also supported the bill.

Another point is the reference centers.

On this point we make more reservations. It is also not essential in the proposal. We must have centers of excellence, but we must also define them. They can also be misunderstood. Our first intention should not be to create the image now, through the international movement of patients, that only in Belgium can be provided the best and most interesting care. After all, good health care is a task that must come everywhere from a more socializing Europe. Not only in Belgium must the health care be good; it is throughout the European Union that we must have a good health policy.

Colleagues, Mr. Van der Maelen, you have sufficiently understood that we stand behind the bill, that it was an extension of your resolution, Mr. Germeaux, which we also approved at the time. It was therefore logical that we would also support the present bill. It implemented the resolution.

This is an interesting parliamentary work. So often resolutions are drafted here, which remains thereafter. They send in the large pot of all kinds of resolutions. However, the President claims that there is a leverage, that resolutions are regularly reviewed and that they are followed up. However, I note that they usually remain dead letter.

Here, on the other hand, the resolution was transformed into legislative work, with the great merit that it still ...

Mr. Goutry, Mrs. Vautmans wishes you to comment slightly on the resolutions.

Mr. Goutry, I don’t know if you know, but we recently approved a change to the Rules of Procedure. The policy notes of the ministers must implement the resolutions.

I have found that in the most recent policy notes the resolutions were implemented.

We may have different opinions on this, Madame, but I will give you — it would lead us too far, I think, to do this here tonight — the list of the non-executed resolutions under eight years old, which I have drawn up. I can assure you that I will have to stick two stamps on my letter, because the weight will be slightly too heavy for a normalized shipment.

However, it is small typed, with little spaces. I listed them all with the number. You will be able to check it and you will find—per ⁇ to your own surprise, and also to mine, because I did not know it was so bad—that so many resolutions have not been implemented. That is, of course, where we send as Parliament, where we become unreliable, and where we, let us say, disappear in the night darkness, because we do not harden our resolutions.

This time we did it. Congratulations to! Indeed, I would like to join, also on behalf of our group, with the praise for the work and the energy that it required. is is . This is an example of better legislative work, for which I thank you.

Thank you, Mr Goutry.

Can I give the last word to the initiator of the resolution ab ovo, Mr. Germeaux? Mr Germeaux, you are the last speaker in the general discussion.

Mr. Speaker, Mr. Minister, I have a preparation of 35 pages, but I will not read it. It is not intended that you will be busy here tonight with a whole theory according to Mr. Goutry.

No, the only thing I would like to say, Mr. Minister, on this topic – that is very important and Mrs. Avontroodt has also clearly cited that – is that Europe is not at our door, but for us. This problem has been underestimated too often and too long. I look at those in the committee who contributed to the resolution. Mr. Minister, you have given this a very good wording. I was pleasantly surprised by the way you defended the resolution at the time, but ultimately this resolution – I may be going to use a dangerous term – is Bolkestein Light. At the time of thinking about the free movement of patients, we were confronted with the free movement of services in Europe. On the one hand, one can fear it, on the other hand, one can wonder where the opportunities are. Ms. Avontroodt has made it very clear where there are opportunities.

I have only two things to say today, Mr. Speaker.

First, if there was unanimity on the resolution, I think that unanimity still exists today. We must also be careful of doing dangerous things tomorrow or aftermorrow. This is not the purpose of this bill. It is clear and clear that this bill does not regulate medical tourism. No, indeed, as previously stated – both by Mr. Goutry and by Mrs. Avontroodt – it is about regulating what is contained in the resolution and which is requested from the government to implement it. This is a clear and honest signal. Whether it is the financing of hospitals on the one hand, on which Mr Vandeurzen has so focused, or on the fairness of the redistribution and collection of resources on the other hand, it is about that this must be a means in an initial phase to provide alternative financing for a health care that is optimal in this country. We can refer to knowledge economics and many other arguments, but it is important that one understands that. That is why I am here to say two things. Again, we do not regulate medical tourism. That is not our intention. On the other hand, we want to come to a fair financing of the concerns that this country also wants to offer to others in the European Community – legally decided – and beyond. There was no more ambition. On the other hand, this means billions on the ground that are very important in the financing, for example, of hospitals.

I hope this has made it clear that tomorrow, in the translation of the bill, it will not suddenly take a different direction. Mr. Minister, you have also stated this clearly and I have also followed you in the last months in the reasoning on this subject. The Bolkestein Directive is one thing, a social Europe is something else. I think we have here given a starting point of how we see this in concrete terms.